Unbundling bundles

Unless you were lucky enough to be on an extended summer vacation, you know that CMS proposed to halt bundled payment programs for Episode Payment Models (EPMs) for MI and bypass surgery and the Cardiac Rehabilitation Incentive (CRI) payment model. (Public comment on the changes can be made through October 16th.)

The move will close a path for cardiologists to qualify for the 5 percent bonus in the Advanced Alternative Payment Models (AAPMs) payment track but opens the opportunity for facilities to work independently to more tightly integrate care coordination and improve financial and performance accountability for episodes of care.

Of late, we know managing the costs of episodes of care has become a priority for cardiovascular providers. Many health systems, hospitals and departments have invested significant time and resources prepping. Even though CMS appears to be cancelling cardiac bundles for now, episodic cost scrutiny will only intensify going forward. More episodic cost measures within pay-for-performance and pay-for-reporting programs will be part of the landscape.

CMS is considering retaining EPMs and CRI, but on a voluntary basis, a move supported by both CMS Administrator Seema Verma, MPH, and HHS Secretary Tom Price, MD. Voluntary programs could start as soon as CY 2018, CMS teased earlier this month.

The holy grail is always higher quality, more coordinated care at lower cost which can only be achieved when physicians, caregivers and administrators are working together. We have many of the right ingredients for success: More integrated health systems will help as do information-rich, collaboration-friendly EMRs and most physicians and practices now working for hospital groups. Improved collaboration with cardiovascular service lines and keeping heart teams at the center of care help too.

Fans and critics alike agree the halt gives hospitals more time to prepare. It’s a deep breath for cardiology. But readiness is inconsistent and challenges are a-plenty. Time is ripe for refining strategies for risk-bearing reimbursement models and better care coordination and processes across the continuum. Think improved resource stewardship, cooperation and coordination among disparate medical services. Improve the most, save the most. Previous tries at bundled payments in the private sector have shown improvements in some quality measures and modest savings for payers. While the CMS mandates were perhaps too aggressive, clinically integrated networks that can operate under risk-based contracts will emerge the frontrunners.